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about her leg, or about the accident, that neither the sister ofthe ward nor her friends could speak to her on the subjectwithout an outburst of hysterical excitement, which at oncechecked any further discussion. It was decided, therefore,that nothing should be said to her concerning the loss of herleg until she had nearly recovered; but it was hoped thatbefore that time arrived she would have discovered the factfor herself. This, however, she failed to do; for as she an-nounced to the nurse from time to time that she could feel hertoes, she was fully convinced that they were present. Andher apparent dread of realising the actual state of her limbprevented her from ever looking at it whilst it was beingdressed. When the announcement was made to her that her

leg was gone, some hysterical crying followed; but she wasthen sufficiently recovered to be able to hear reasoning, and torightly appreciate what had been done for her.

SEAMEN’S HOSPITAL, " DREADNOUGHT."LARGE ANEURISMAL SAC CONNECTED WITH THE ARCH

OF THE AORTA, AND OCCUPYING THE WHOLECERVICAL REGION.

(Under the care of Dr. WARD.)THE following case is interesting from the great size of the

aneurismal sac, and the rapidity with which it was developed.The internal and middle coats of the aorta had, no doubt,given way from ulceration, and when the sac had extended upfrom behind the sternum it met with but little resistance toits rapid increase from the yielding structures of the neck.Evidences of disturbed nervous function were exhibited in thesevere pain over the tumour from direct tension of contiguousnerves; in more distant pain, as over the mastoid process,from irritation of branches of cervical nerves, and in thenumbness at the side of the neck and down the shoulder.The affection of voice and dyspnoea were less severe and

paroxysmal than when dependent on irritation of the recurrentlaryngeal nerves, and were due to direct pressure of the tumouron the larynx.

This was the second case of aneurism under the care of Dr.Ward in which the application of ice produced serious symp-toms. In two other cases it had, however, been followed bygood results.

T. S-----, able seaman, thirty-four years of age, a well-nourished man, of lymphatic temperament, was admitted onDec. 28th, 1866. He stated that he had always been of tem-perate habits; that he had never had acute rheumatism orsyphilis or ague. He had been troubled, however, for the lasttwo months with what he called rheumatic pains in differentparts of the body, and had experienced once or twice severepain behind the right ear, and also a sense of numbness in theShoulder and neck of the right side. There were no symptomson his admission to direct particular attention to his chest.He was ordered bark and iodide of potassium, and milk andbeef-tea. A few days after his admission he complained ofUneasiness at the lower part of the neck, and on examinationa small pulsating tumour was observed just above the sternalend of the right clavicle ; there was no bruit over the tumouror ascending aorta, and the heart-sounds, although feeble,were normal; the radial pulses were barely perceptible, theright being weaker than the left. The tumour rapidly increasedin size, and by Jan. 25th, 1867, it occupied the lower half ofthe cervical region, measured ten inches across, and had

pushed the trachea an inch beyond the mesial line to the leftside. It presented a strong impulse and distinct fluctuation,but there was no bruit immediately over it. On examiningthe chest there is found harsh breathing over the left supra-clavicular region, and a marked bruit is heard between the leftscapula and the spine, and in less intense degree above andbelow the left clavicle. Breathing on right side is natural,but before and behind an impulse is detected. Twice withinthe last fortnight he has experienced the severe pain over themastoid process which he felt when first attacked. The voiceis somewhat affected at times, and there is occasional ratherSevere dyspnoea ; he has frequent tendency to syncope, andnow and then complete blindness ; the pupils are regular andact equally; the capillaries of head and face are much injected;he suffers constant pain over the tumour. He is incessantlyrestless, and gets but little sleep. The bowels are confined,and the urine is loaded with lithates. He takes his food well,and is in fair condition, The application of ice was tried, but

it induced intense uneasiness and delirium, and had to he dis-continued.On Jan. 28th the tumour had increased, the skin over it was

tense and red, and seemed to be pointing just above the rightsterno-clavicular articulation. On Feb. 1st the tumour mea.sured twenty inches from side to side; the patient’s generalsymptoms were, however, less distressing : he breathed better,complained less of pain, and slept at intervals. On the 9th hphad some epistaxis, and some indications of slight lung con.gestion. The tumour continued to increase, and gradually tooccupy the entire cervical region, and in the forty-eight hourspreceding Feb. 21st its increase was very marked. The radialpulses continued equally weak, and at times scarcely palpable.The swelling of neck when seen from behind seemed greateron the left than on the right side.On the 1st March he exhibited distinct indications of pul.

monary congestion, in the shape of crepitation over both lungsposteriorly, dyspnoea, and expectoration of sputa either rustyor more distinctly marked with blood. There was no directhiemorrhage, however, either now or at any period of the ill.ness. The patient remained conscious to within half an hourof his death, the immediate cause of which was asphyxia.Post-morten examination.—The right clavicle was dislocated,

and there was extensive caries, which had commenced on alevel with the second rib on the right side, and included thisrib, the first rib, and the adjacent parts of the clavicle andsternum. The left lung was simply congested; the right wagemphysematous at the apex, and there were some slight adhe.sions and about four ounces of serous fluid in the right pleura.The tumour was removed from below upwards, and consistedof a large aneurismal sac, proceeding from the arch of theaorta. It had its limits below at the level of the second rib,and above at the level of the third or fourth rings of the trachea. It extended laterally more to the left than to the rightside, and its walls were so thin anteriorly that great care wasrequisite to avoid their rupture. The sac was opened by avertical incision on its anterior aspect, and the clots removedfrom it weighed two pounds two ounces. A lare fibrinousclot was also removed from the ascending aorta. The arteriainnominata, the left carotid, and the subclavian were not in-volved in the dilatation. The heart and its valves were foundto be healthy. An extensive amount of atheromatous diseaseexisted along the ascending aorta, and was most marked aboutthe curvature of the vessel. The liver and kidneys werenormal.

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LONDON HOSPITAL,

REMARKS ON THE OCCASIONAL UTTERANCES OF"SPEECHLESS" PATIENTS.

(By Dr. HUGHLINGS JACKSON.)ALTFOUGH we report the following remarks under the head.

i ing London Hospital, it will be observed that some of the casesrelated are those of inmates of other institutions whom Dr.

Hughlings Jackson was permitted to see by the medicalofficers-Dr. Moore, Dr. Edward Richardson, and Mr. Norton.

Dr. Hughlings Jackson tells us that he has recently seen theman to whose case we briefly alluded in a report (" Mirror, "Feb. 17th, 1866) of some remarks this physician made onIntellectual and Emotional Language. When the poor fellowleft the London Hospital he was able to utter the word" Dick" only, except that he swore when vexed. He is nowin a workhouse, where, thanks to the permission of Dr. E. H.Moore, Dr. Hughlings Jackson saw him a few weeks ago.Strange to say, the patient’s stock phrase is now " Jimmy ;"he never says "Dick." Although it is two years since the

patient left the hospital, as soon as he saw the doctor he raisedhimself eagerly from his chair, offered his left hand--his rightis still paralysed,-and cried out very vivaciously, ‘‘ Jimmy,Jimmy," &c., evidently pleased to see some one whom heknew. The ward superintendent says the patient sometimessings; that the word he then uses is " jigger.’’ He is usuallyquiet; but when vexed he swears, or rather utters a very nastyword, the last syllable of which rhymes to the last syllable ofjigger. He cannot say this word when he tries; but, whentrying, says "Jim" instead. "Jimmy" seems to be the wordhe uses as an ejaculation to show states of feeling, and " Jim"when he is trying to convey information. When asked toshow how many children he had, he extended his left fivedigits twice, and at each extension he uttered jerkingly the